A novel treatment for supraglottic stenosis secondary to immunoglobulin G4-related disease.

Although immunoglobulin G4-related disease (IgG4-RD) has a predilection for the head and neck region, laryngeal pathology is rare. We report a case of supraglottic stenosis due to IgG4-RD together with a novel treatment strategy of employing a laryngeal stent. A 69-year-old man was referred with longstanding dyspnoea and worsening inspiratory stridor. Despite two supraglottic dilations over a 12-month period, his stenosis recurred and symptoms persisted. Serum investigations revealed elevated IgG4 levels (2.390g/l), with IgG4 infiltrate in laryngeal biopsies. The patient underwent endoscopic balloon dilation, intralesional Depo-Medrone® injection, CO2 laser therapy and insertion of a laryngeal stent to prevent re-stenosis. Rituximab and prednisolone were commenced postoperatively and the stent was removed at 6weeks. No stenosis recurrence was visualised over a further 12-month follow-up period. Sixteen cases of laryngeal lesions with confirmed IgG4 infiltrate in biopsies have been reported in the worldwide literature to date. Based on a literature review and our experience, we recommend that similar laryngeal pathologies undergo early IgG4 serological testing and biopsy immunohistochemistry. Prompt diagnostic confirmation may prevent unnecessary surgical interventions and optimise immunosuppression. Furthermore, the use of a laryngeal stent following laryngeal surgery may help reduce stenotic recurrence and promote healing.

Patient satisfaction from ENT telephone consultations during the coronavirus disease 2019 pandemic.

BACKGROUND: Telephone consultations have rapidly increased in the out-patient setting because of the coronavirus pandemic. A quality improvement project was implemented to improve patient satisfaction of telephone consultations in our unit. METHODS: This was a prospective complete-cycle project. Patient satisfaction questionnaires were sent to patients following telephone consultations in ENT clinics. Based on a literature review and initial results, clinicians were encouraged to follow a structured consultation format. A second questionnaire survey was conducted following its implementation. RESULTS: One hundred patient questionnaires were collected during the survey (April and June 2020). There was significant improvement over the two surveys in terms of satisfaction scores (p = 0.026), along with a significantly increased preference for telephone consultations over face-to-face consultations (p = 0.021). CONCLUSION: This study showed significant improvement in patient satisfaction and an increased telephone consultation preference through the use of a structured consultation model. The potential benefits in terms of infection control and impact on out-patient workload may see telephone consultations persist in the post-coronavirus era.

A multi-centre analysis of a decade of endoscopic pharyngeal pouch surgery in Cheshire and Merseyside.

BACKGROUND: There are sparse data on the outcomes of endoscopic stapling of pharyngeal pouches. The Mersey ENT Trainee Collaborative compared regional practice against published benchmarks. METHODS: A 10-year retrospective analysis of endoscopic pharyngeal pouch surgery was conducted and practice was assessed against eight standards. Comparisons were made between results from the tertiary centre and other sites. RESULTS: A total of 225 procedures were performed (range of 1.2-9.2 cases per centre per year). All centres achieved 90 per cent resumption of oral intake within 2 days. All centres achieved less than 2-day hospital stays. Primary success (84 per cent (i.e. abandonment of endoscopic stapling in 16 per cent)), symptom resolution (83 per cent) and recurrence rates (13 per cent) failed to meet the standard across the non-tertiary centres. CONCLUSION: Endoscopic pharyngeal pouch stapling is a procedure with a low mortality and brief in-patient stay. There was significant variance in outcomes across the region. This raises the question of whether this service should become centralised and the preserve of either tertiary centres or sub-specialist practitioners.